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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800447
Report Date: 03/14/2025
Date Signed: 03/14/2025 12:57:16 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/07/2022 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20220707102506
FACILITY NAME:GRATEFUL HEART HOME CARE INCFACILITY NUMBER:
331800447
ADMINISTRATOR:UY, CHARMAINEFACILITY TYPE:
740
ADDRESS:14223 POINTER LOOPTELEPHONE:
(951) 427-1800
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY:6CENSUS: 6DATE:
03/14/2025
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Assistant Administrator Chantelle FukaTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Facility did not provide resident transportation to medical appointments.
Facility did not provide resident adequate care and supervision.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Assistant Administrator Chantelle Fuka and explained the purpose of the visit. The investigation consisted of staff and resident interviews.

For the allegation, Facility did not provide resident transportation to medical appointments

LPA Hernandez conducted 3 resident interviews. 1 out of the 3 residents stated their family members help them with scheduling their medical appointments and with transportation. 2 out of the 3 residents stated the facility staff helps schedule their appointments and help with transportation. LPA Hernandez conducted (4) staff interviews. 4 out of the 4 staff stated residents have family that schedule and transport them to their appointments, while the other residents received help from staff and with transportation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 56-AS-20220707102506
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: GRATEFUL HEART HOME CARE INC
FACILITY NUMBER: 331800447
VISIT DATE: 03/14/2025
NARRATIVE
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For the allegation, Facility did not provide resident adequate care and supervision.

LPA Hernandez conducted (3) resident interviews. 3 out of the 3 residents stated facility staff provides adequate care and supervision. Additionally, 3 out of the 3 residents stated facility staff help care for their personal needs. LPA Hernandez conducted (4) staff interviews. 4 out of the 4 staff stated they do provide adequate care and supervision to all residents in care and have not witnessed any staff not providing care or supervision.

Based on the evidence gathered during today’s investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

During today’s visit, no deficiencies were cited pertaining to these allegations per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Assistant Administrator Chantelle Fuka.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2